reproducibility of gleason grading system for prostatic adenocarcinoma dr a. t atanda, consultant...
Post on 14-Dec-2015
221 Views
Preview:
TRANSCRIPT
REPRODUCIBILITY OF GLEASON GRADING SYSTEM FOR PROSTATIC ADENOCARCINOMA
Dr A. T Atanda, Consultant Pathologist, AKTH, kano
Introduction Qualitative versus Quantitative data Grading in histopathology Why Carcinoma of the Prostate
Grading is important (Gleason System)
Epidemiological significance of Ca Prostate
Role in determining treatment option
Role in determining prognosis Inappropriate Treatment
Interpretation of kappa values
<0 Poor 0.01 – 0.2 slight reproducibility 0.21 – 0.40 fair reproducibility 0.41 – 0.60 moderate reproducibility 0.61 – 0.80 substantial reproducibility 0.81 – 0.99 almost perfect
reproducibility
Grade 2 round or oval closely arranged intermediate-sized glands with smooth ends and invasion into the surrounding non-neoplastic prostatic tissue.
Grade 3 rounded well circumscribed cribriform glands of the same size as normal glands and resembling high grade intra-epithelial neoplasm
Grade 4 large cribriform glands with irregular borders with ductal differentiation
Grade 5 solid sheets of cells and cribriform glands with comedonecrosis
Primary Gleason Pattern Rating 110 ratings Patterns
1 3 2.7% 2 38 34.5% 3 32 29.1% 4 18 16.4% 5 19 17.3
Compared to consensus Under-rating 54 49.1% Appropriate rating 52 47.3% Over-rating 4 3.6%
Primary Gleason Pattern Rating
Range of kappa 0.07 to 0.47
Performance (kappa distribution) 2 18.1% slight 5 45.5% fair 4 36.4% moderate
Overall kappa = 0.25 (fair agreement)
Primary Gleason Pattern Rating
Intra-rater consistency for Gleason pattern 3 0.29 – 0.78 3 27.3% fair 5 45.4% moderate 3 27.3% substantial
Intra-rater consistency for Gleason pattern 5 0.29 – 0.78 5 45.4% fair 4 36.4% moderate 2 18.2% substantial
Slide
No.
Consens
us
score
Gleaso
n
2 – 4
Gleason
5 – 6
Gleason
7
Gleason
8 – 10
1 8 2 2 4 3
2 5 8 3 0 0
3 8 1 1 5 4
4 5 6 5 0 0
5 10 0 1 1 9
6 9 3 6 2 0
7 5 1 6 3 1
8 10 0 0 1 10
9 6 2 9 0 0
10 7 1 6 1 3
Total 24 39 17 30
Gleason Score Rating
110 ratings Score groups
2 – 4 24 22% 5 – 6 39 36% 7 17 15% 8 – 10 30 27%
Compared to consensus Scores Under-grading 51.8% Appropriate grading 40.9% Over-grading 7.3%
Gleason Score Rating Group under-grading
5 – 6 38.6% 7 63.6% 8 – 10 45.5%
Kappa distribution for Gleason Scores 0 – 0.20 – to 0.54 6 54.5% slight 2 18.2% fair 2 18.2% poor 1 9.1% moderate
Overall kappa = 0.35 fair
Summary Pattern recognition was only fair (kappa =
0.25)
Underrating of primary Gleason pattern occurred in 49.1% of ratings
Intra-rater consistency was higher for Gleason pattern 3 than for pattern 5
There was no statistically significant difference between participants
Summary ctd Inter-rater agreement for Gleason score was fair (kappa = 0.35)
Under-grading occurred in 51.8 % of ratings overall
Grade 7 was most under-graded (63.6% of ratings)
Authors Kappa for GS
Our study kappa
McLean et al (1997)
0.16 – 0.29 – 0.20 – 0.54
Djavan et al (1998) 0.148 – 328 – 0.20 – 0.54
Allsbrook et al (2001)
0.56 – 0.70 – 0.20 – 0.54
Melia et al (2005) 0.08 – 0.58 – 0.20 – 0.54
Singh et al (2011) – 0.11 – 0.82 – 0.20 – 0.54
Factors identified for imperfect inter- and intra-rater agreement
Underscoring
Dearth of expertise in uropathology
Low awareness of current reviewed Gleason grading system (ISUP, 2005)
Infrequent refresher tutoring
ISUP Recommendations Patterns 1 or 2 should
rarely be assignedGleason Scores 2 – 4 rarely in needle biopsies
Cribriform 3 now rendered 4
Need for immunohistochemistry (p63 staining)
Conditions for pattern 2
p63 demonstration of loss of basal staining
Perineural, glomeruloid features
Extra-prostatic extension
Cribirform pattern 3 conditions
p63 demonstration of loss of basal cells
Presence of extra-prostatic extension
Perineural invasion
rounded well circumscribed cribriform glands of the same size as normal glands and resembling high grade intra-epithelial neoplasm
top related